The agreement of fingertip and sternum capillary refill time in children.

OBJECTIVES: To determine the agreement of fingertip and sternum capillary refill time (CRT) in children. DESIGN: Prospective, method-comparison study. SETTING: Single children's emergency department, UK PARTICIPANTS: 92 children aged 0-12 years, with clinical observations within normal ranges for their age, no relevant medical history and presenting to hospital with a minor illness or injury. MAIN OUTCOME MEASURES: Agreement between fingertip and sternum CRT measurements. RESULTS: Fingertip CRT ranged from 0.05 to 2.78 s with a mean of 1.08±0.44 and sternum CRT ranged from 0.85 to 2.38 s with a mean of 1.5±0.33. There was a significant difference between fingertip and sternum CRT (t=-9.2, df=91, p=<0.001) and a weak association between the two measurements (r=0.18, p=0.9). A Bland Altman comparison showed the mean difference between fingertip and sternum CRT was -0.49±0.51 with an upper and lower limit of agreement ranging from -1.5 (95% CI -1.69 to -1.32) to 0.53 (95% CI 0.34 to 0.71). CONCLUSIONS: Measurements of CRT taken at the fingertip and sternum are not comparable. Fingertip CRT was faster than sternum CRT. Normal CRT is 2-3 s. The current study questions the usefulness of CRT in the assessment of circulation in children.

Fever management: evaluating the use of ibuprofen and paracetamol.

Paracetamol and ibuprofen are safe and effective medications for reducing a fever in children and young people and they are often administered together with a view to reducing a temperature quickly. National Institute for Health and Clinical Excellence guidelines dictate that only one of these drugs should be given at a time because there is no evidence to suggest that simultaneous use is more effective. This article summarises a literature search of randomised controlled trials carried out to identify which, if either, of these drugs is faster at reducing a fever. In the studies examined, ibuprofen was found to be marginally more effective. However, the maximum dose of paracetamol was not administered. There is a need for more methodologically sound research that uses equivalent doses of both drugs.